Akovbiantz A, Brühlmann W, Deyhle P
Schweiz Med Wochenschr. 1975 Jun 7;105(23):741-5.
The value of endoscopic retrograde cholangiopancreaticography (ERCP) for establishing the indication for surgery and for planning surgical procedures is discussed. The two most widely practiced methods of direct cholangiography - percutaneous transhepatic and endoscopic retrograde cholangiography (PTC and ERC) - are compared: although the filling rate with ERC is slightly lower than with PTC, the endoscopic method has some important advantages as it allows endoscopic observation and biopsy of the duodenum. Furthermore, opacification of the pancreatic duct system often provides important additional information. ERCP is essentially important in post-cholecystectomy syndrome, as puncture of undilated bile ducts is difficult and persistent symptoms after cholecystectomy are not infrequently related to pancreatic disease. The importance of rapid surgical intervention after retrograde filling of the biliary tree in obstructive jaundice is stressed. In pancreatic diseases the indication for surgery is based mainly on clinical and laboratory findings. Differentiation of malignant and inflammatory changes in the pancreaticogram is still a problem. However, the contribution of ERCP to pancreatic surgery is very important, as it exactly localized lesions of the pancreas and therefore allows detailed planning of a surgical procedure. Stenosing or obstructing lesions often are an indication for surgery, even if their malignant nature is not certain, as severe pain in chronic pancreatitis may be relieved by surgery. The potential for therapeutic application of endoscopy in biliary and pancreatic diseases is briefly discussed.
讨论了内镜逆行胰胆管造影术（ERCP）在确定手术指征和规划手术操作方面的价值。对两种最常用的直接胆管造影方法——经皮经肝胆管造影术和内镜逆行胰胆管造影术（PTC和ERC）进行了比较：尽管ERC的充盈率略低于PTC，但内镜方法具有一些重要优势，因为它允许对十二指肠进行内镜观察和活检。此外，胰管系统的显影通常能提供重要的额外信息。ERCP在胆囊切除术后综合征中至关重要，因为未扩张胆管的穿刺困难，且胆囊切除术后持续症状常与胰腺疾病有关。强调了在梗阻性黄疸中胆管树逆行充盈后迅速进行手术干预的重要性。在胰腺疾病中，手术指征主要基于临床和实验室检查结果。胰管造影中恶性和炎症性改变的鉴别仍然是一个问题。然而，ERCP对胰腺手术的贡献非常重要，因为它能精确地定位胰腺病变，从而允许对手术操作进行详细规划。即使狭窄或梗阻性病变的恶性性质不确定，它们通常也是手术指征，因为慢性胰腺炎的剧痛可能通过手术缓解。简要讨论了内镜在胆道和胰腺疾病中的治疗应用潜力。
